NHS Reset: Sustaining the digital revolution

The digital transformation of healthcare during the pandemic has been nothing short of remarkable.

In primary care, it happened literally overnight. Graphs of GP appointments show that, on 9 March, face-to-face appointments began a dramatic plunge while telephone consultations soared. NHS Digital statistics show that 48 per cent of all appointments in April were conducted by phone. 

The ‘total triage’ approach championed by NHS England and NHS Improvement and readily adopted by the profession has led to unprecedented use of online consultations to funnel demand and provide timely responses to patients.

Video consultations have become more popular; some GPs are now conducting weekly ‘ward rounds’ by video in nursing homes. Millions more patients have adopted digital tools to give them greater control over their own healthcare.

There has been a dramatic rise in the use of electronic prescriptions; over 95 per cent of all prescriptions in England are now digital. This is transformational and supports pop-up clinics and the reconfiguration of other frontline services.

Primary care’s online banking moment

There’s no doubt that primary care is having its ‘online banking moment’. The move to digital-first primary care has been built on years of investment in hosted, electronic medical records, NHS services such as EPS and online patient services such as Patient Access, which have all underpinned the response to COVID-19.

Close collaboration between NHS Digital and suppliers has accelerated existing projects (such as GP connect) and rapidly established new services such as a national Shielded Patient List shared between primary and secondary care.

Commissioners, clinicians and patients have actively embraced new models of care and moved the dial in terms of digital adoption.

So where do we go from here?

The National Audit Office’s latest report on digital transformation in the NHS is a timely reminder of the scale of the challenge. It reminds us that progress has been slow and many obstacles need to be overcome, including large-scale process and behavioural change alongside significant investment.

But the pandemic has shown us what can be achieved – quickly and safely, at scale – when the will is there. So let’s be bold and imagine how we can reset a digital NHS for 2021 and beyond.

The new normal – virtual by default

NHS Confederation chief executive Niall Dickson has said we should see 'virtual by default' as the new normal in key areas of delivery.

I agree, and if we are already providing some services in this way, why go back to old models once we are out of the pandemic?

Now is the time to capitalise on the newfound confidence among clinicians and patients, and to use COVID-19 as a springboard to a better digital future. But we must also be very mindful that digital services aren’t for everyone, and that it will be more important than ever to look after vulnerable people and those who can’t access or find it hard to use online tools.

Insight can change the world

But there’s a much bigger opportunity we can seize. The government’s relaxation of data-sharing and data access rules via emergency control of patient information (COPI) notices has literally revolutionised legitimate access to NHS data and shown us what’s possible in the future.

Patient data is now safely flowing from GP systems to secondary care to support the diagnosis and care of patients with COVID-19 and it is vital this continues beyond the pandemic.

The safe, ethical and legal use of aggregated data from multiple care environments will not only enable us to better fight the pandemic through better surveillance, but will also enable new insights into COVID-19 (for example, why there is a disproportionate impact on the BME community).

It will also enable the NHS to have a deeper understanding of the impact on long-term conditions, cancer diagnoses, the performance of screening and vaccination programmes.

And it gives us a unique opportunity to plan how to best target interventions so that we reach those who are most in need. This can deliver a step-change in the care of those with long-term conditions. Using a risk-based approach, we can ensure we target those people who most need help – perhaps even before they present to ask for it.

Over the next few months, we need to look at the effects of the COPI notices on NHS care delivery, on insight into the impact of COVID-19 and at how they can support the development of new tools to risk manage. We must also consider privacy and professional concerns.

I expect this will result in a paradigm shift in how the NHS uses data in a positive way to improve UK healthcare. The potential benefits are so great that it will be very hard, if not foolhardy, to return to the pre-COPI model.

So, going forward, let’s be bold. Let’s not lose the pragmatic approach that has achieved so much during the pandemic. Let’s build long-term benefits from the lessons we have learned so quickly during this tough but incredible period in human history.

Dr Shaun O’Hanlon is chief medical officer at EMIS Group. Follow him and the organisation on Twitter @drshaun @EMISGroup